MiniBAV through distal radial only
#CardioTwitterCase originally published on Twitter
From a clean puncture to a safe valvulotomy, a step by step video tour through performing distal radial MiniBAV – a novel technique.
This case was originally published on Twitter by @AlexAchimMD
Case description
The relevance of balloon aortic valvuloplasty (BAV) in the management of aortic stenosis has resurfaced. The predominant access for BAV remains the femoral artery, although radial artery can safely accommodate 6-10F sheaths with subsequent new, more flexible compatible balloons.
We present a case of a 82 years old male with critical aortical stenosis who underwent BAV through dual distal radial approach (Figure 1).
Figure 1 – Intraprocedural illustrations: (1) dual 6F distal radial access (arrows), (2) right radial exchange with 7F sheath (3) rapid pacing with negative lead (blue) attached to the stiff wire, positive lead (red) attached to a needle which is inserted subcutaneously in the leg, (4) bandage compression with elastic band, the thumb is left free.
Old and frail adults benefit from a quick recovery and the femoral arteries remain intact for a second session TAVI. Using ultrasonography before and during the puncture we believe is the key to success. There is a certain learning curve.
Rapid pacing was performed through the 0.035’’ stiff wire and because semicompliant balloon material enables some variation of diameter above or below the nominal level, 16-18 mm sizes are enough for a 0,8 balloon to annulus diameter ratio and at least 30% drop in mean gradient pressure.
If not, bilateral distal radial BAV with simultaneous balloons is also feasible (Figure 2).Device retrieval might be problematic, in this case long destination sheaths could be utilized.
Figure 2 – Bilateral distal radial aortic valvuloplasty with simultaneous balloons (double 12x40 mm 7F compatible balloons, VACS II Osypka AG, Germany).
Video
Final remarks
In conclusion, dual distal radial artery access is a safe and effective option for balloon aortic valvuloplasty in patients with severe aortic valve stenosis and can be performed in all patients with sufficient lumen diameter (min. 2.0 mm).
Original tweet and Twitter discussion
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